Posted: Monday March 21, 2011 10:42AM ; Updated: Monday March 21, 2011 3:26PM
Will Carroll
Will Carroll>INSIDE FANTASY

Under The Knife: Utley's return likely a matter of mind over pain

Story Highlights

Baseball teams lost more than $1 billion to injuries in the last five years

Chase Utley's creaky knees may requite stint on DL and injection into knee

Carlos Beltran is trying to avoid microfracture surgery Grady Sizemore had

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Chase Utley's ability to play through the 2011 season on sore knees for the Phillies may rest on his pain threshhold.
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There's only two ways to win in baseball: (1) have a lot of talent, and (2) keep it on the field. My focus here is on the latter. For the past nine years, I've been writing about the game of baseball through a unique lens. Injuries in baseball are as decisive in impact as a trade, a career year or a free-agent signing, yet few seem to understand just how important sports medicine is to a team's chances. It's easy for Cardinals fans to understand when they lose Adam Wainwright to elbow surgery, but there are questions beyond this: Could it have been prevented? When will he come back? Will he be the same? Those answers aren't absolutes, but they're knowable. (Quick answers: no, next year and yes.)

Baseball teams lost more than $1 billion to injuries in the past five years, money I have to imagine teams would rather have in their pockets or on the field playing baseball. This is an area where the interests of the owners, the players and the fans line up, yet in the grand scheme of things no one is doing anything to improve it. There are a few teams pushing things forward, but no one has found a Moneyball-style advantage ... yet. It's there and it's coming, but in a world where no team is spending even 1 percent of its payroll on research and prevention, it's not coming fast. So much of these next few decades will be determined by the Dodgers' ability to keep Clayton Kershaw on the Felix Hernandez track instead of the Kerry Wood track. The Phillies' move from good to dynasty hinges on their ability to keep Ryan Howard, Jimmy Rollins and Cole Hamels on the field and productive. Pennants will be won or lost by the medical and training staffs who never step onto the field ... and yet few pay attention to this key part of the game.

For those new to my work on baseball, let me explain what I do: I'm not a doctor, nor do I play one on TV. I talk to a network of sources around baseball as well as a team of advisors that include some of the best sports medicine doctors, trainers and therapists around. I also maintain a database of MLB injuries that helps me to determine comparables and normal time periods for injuries. I put all of this together to help guide you as to the severity and duration of an injury. You'll see a condition and an expected return date (ERD) on each header. The expected return date is a best guess of when that player will return. It's not hard and fast in most cases, but it changes as the information I'm able to get changes. New info equals new ERD, so use it as a guideline. If I don't know, you'll see "TBD" for "to be determined." If a player is done for the season, you'll see "9/30", which is the last date of the season. If you don't see a date, that means that the player isn't expected to miss time, but that the injury is worth discussing for me, and watching for you and your fantasy team. I'll cover the top injuries in more detail, then do some shorter comments in "Quick Cuts." You might get a bit lost in some of the lingo, but stick around -- before long, you'll be a medhead too. Now, powered by Peet's Kenya Auction Lot, on to the injuries:

Chase Utley, Phillies (arthritic knees, TBD)

The news on Utley has gone from concerning to quite concerning over the past two weeks. The initial reports haven't changed, but the interpretation of those reports has changed in the absence of any signs of progress. Utley has "old guy's knees" -- creaky, arthritic and sore -- while the question has always been more one of function than of problem. The Phillies are taking their normal conservative course, knowing that using Utley in Spring Training is counterproductive. He's seen several doctors, including unconfirmed reports that he's seen or spoken to Dr. Walt Lowe, who is one of the pioneering doctors doing meniscal transplants, a procedure that has not yet been performed on an elite athlete. Utley may well begin the season on the DL, but it doesn't seem that he's gone through all the steps between where he was a few weeks ago and something as desperate as a transplant. It wouldn't surprise me at all to see those steps, something like the use of Synvisc, a lubricating gel that is injected into the joint space, over the next week.

This will really come down to how well the Phillies' medical staff can keep Utley functional and how much pain Utley is willing to take. One thing to keep in mind is that Utley is a known risk. It's surprising to me to see so many fantasy players discounting Utley, but ignoring the injuries that dot Rickie Weeks' history, for example.

Zack Greinke, Brewers (fractured rib, 4/12); Shaun Marcum, Brewers (sore shoulder)

The Brewers' status as a contender is built around Greinke and Marcum anchoring a rotation behind Yovani Gallardo, while Ryan Braun, Prince Fielder and ... well, someone else ... puts up enough offense against a mediocre NL Central. If there's a hole in the plan, it's the injury risk for all of those players.

Greinke's version of March Madness isn't that big a deal in the grand scheme since he can keep his arm going and his cardio up. Sure, it would be better if he hadn't gone up for that rebound, but he'll miss two, maybe three starts. Look for him to have his first start as one of the Brewers southern affiliates (Nashville or Huntsville) open up the minor league season.

Shaun Marcum gave the Brewers a bit of a scare when he came off the mound in his last start. The team has downplayed things, but Marcum has always been on the edge with his velocity, so any loss there could make him more hittable. Overall, the Brewers' medical staff has had a busy spring, but one of the reasons that Doug Melvin could bring in players like this is that staff and their track record.

Carlos Beltran, Mets (arthritic knees); Grady Sizemore, Indians (post-microfracture surgery)

People lump Beltran and Sizemore together, but they're actually on two sides of a similar issue. Sizemore had microfracture surgery last year to try and correct his chronic knee problem, while Beltran has done everything in the book to avoid a similar fate. It's interesting to see just how much of a mirror their seasons have been. Sizemore started slowly this spring, gradually building up his running and baseball activities, while Beltran was pushed more early to see how he would hold up and if he could stick in CF. Sizemore has made good progress, though he's requiring a close eye from Lonnie Soloff and the Indians medical staff to make sure the maintenance is done daily. Beltran has been hobbled of late with more swelling and soreness, leaving Mets trainer Ray Ramirez trying to catch up with it. Both are very risky, but the risk will go opposite ways. The longer Sizemore plays without issue, the more the risk will go down. Beltran's risk will go up as the additional wear and tear adds to the problem. Some think Beltran could shut it down the way Sizemore did last year to get the microfracture and try to come back like Sizemore, but if Sizemore has more problems, Beltran might be reluctant, knowing that teams will look at it as a major negative on a free agent. Both could start the season on the DL, but right now, no decision has been made, so I won't put up an ERD on either just yet.

Joe Mauer, Twins (post-surgical knee)

Note to self: Give up on the idea that Mauer will be moved from behind the plate while he's in a Twins uniform. They think his value back there trumps the beating he takes and the chance that Mauer is the next catcher to get in a situation like Carlos Santana, or to end up with his knees ground down and his career over early. Sure, some catchers have remained healthy -- Ivan Rodriguez and Mike Piazza come to mind, two players who couldn't be more different. Maybe Mauer can be another one of those, but his knee, leg and back problems don't make me optimistic about it. Mauer's a special talent and last season might have been more impressive than his MVP campaign, having played through a ton of nagging injuries from June on. He fought through them, knowing that without Justin Morneau, he was the Twins offense. His example helped the team around him, one of those intangible things that also factors in when the Twins do have the occasional thought about shifting him to DH.

Brian Wilson, Giants (strained oblique, 4/10)

Closers are always difficult to read in drafts. There's always one that completely explodes on the scene who didn't get drafted, like Neftali Feliz or John Axford. There's always one that implodes despite being a high draft pick. In between, there are some guys you hope will hit 20 saves with upside.

Quick, look back at last year's draft and tell me where Wilson went.

Wilson's beard and World Series ring is going to make him a bit overvalued. Wilson came off the mound over the weekend with a moderate oblique strain, which isn't good for a pitcher who uses so much torque in his delivery. The trick of oblique strains is that they can recur. If a player tries to come back too early, the thin muscle can tear all over again and the process starts again. The Giants will have to be careful with him in the coming weeks, but once he does start throwing, it won't take long to get him back on the mound. In the interim, Sergio Romo is the most likely to pick up the saves in Wilson's absence, making Romo a must-handcuff if you do take Wilson (or already have.)

Jason Heyward, Braves (sore back)

There are a lot of ways to look at the situation with Heyward. The news that he has less cartilage between his vertebrae sounds bad, but is it? One team orthopedist I spoke with said it was interesting, but not meaningful, at least in the short term. It could explain why Heyward is having some chronic issues with his back, but most chronic problems actually come from inflamed spinal discs that cause some impingement or entrapment with nerves that come through their area. Heyward has always had this, so it isn't new, but he hasn't been playing professional baseball that long. This is something that could cause long term problems much more than it is a near term issue.

For some players, having a back issue can really make them "get religion," committing to a strengthening and flexibility problem. Doing that young could make Heyward an even better player. Back in '03, Ivan Rodriguez stepped away from greeting what seemed like an endless stream of well-wishers at Wrigley Field just before his NLCS game. He jogged down, got with a trainer, and went through a series of exercises that didn't just help him then, but made it possible for him to still be catching eight years later. I don't expect Heyward to miss time, but watch to see if he'll need to be spotted out here and there to keep it loose, especially after long flights.

Michael Stanton, Marlins (strained quad)

If there's anyone in baseball with more raw potential than Heyward, it's Stanton. Both have been held down a bit by injuries this spring, though Stanton's is relatively minor and doesn't have the long-term implications of Heyward's back. Stanton has a simple strain of his quad. The Marlins have been conservative with his return, easing him back in with minor league games and DHing. He's still on track for a return well before Opening Day, though the Marlins will continue to be conservative with him for another week. The Marlins want to make sure that Stanton's leg is fully healed and that he can go into his first full season with confidence. He's never going to steal much, but he does have decent speed, with one scout saying, "He has [Albert] Pujols' speed and smarts, as well as power." Assuming there are no more setbacks, this injury is one to put in the rear-view when it comes to assessing Stanton's value.

Kendrys Morales, Angels (broken leg, TBD)

Morales has changed his name, but not his fortunes this off-season. After one of the freakiest injuries in baseball history, Morales is still sore, swollen and lacking some range in his broken ankle. That he's still having trouble this far out from surgery is a huge issue and suggests that he might be at MMI -- maximum medical improvement. That's the technical term for "as good as it's going to get" and that wouldn't be good enough to play full-time. If Morales can't get his ankle back to a usable state, the Angels can easily turn to spring phenom Mark Trumbo, who, at 25, isn't the kind of player that will get the "Super Two Tango" -- sent down to AAA in order to save service time. (Trumbo has had his own issue, a minor groin strain.) The Angels announced that Morales will start the season on the DL, but there's not much clarity on when he will be ready. He'll head for a minor league rehab stint, where we'll need to look for an increase in power, his ability to run and his ability to play day after day.

Quick Cuts

"Bilateral groin release." Yeah, that's as bad as it sounds, but it's freed up Mike Cameron. Reports from Sox camp are that he's running well ... Everything has gone well for Jake Peavy this spring, until now. He had his velocity back and looked good, but he's developed tendinitis in his rotator cuff, a potentially serious problem. The Sox will watch closely over the next couple days to see how he responds, but Opening Day is very iffy. Expect the Sox to be very conservative with him. I'm working hard on this one and expect to have more in-depth info in the next column ... Johnny Cueto came out of a second start with arm issues and has been sent back to Cincinnati. He's not the Opening Day starter, but he could start the season on the DL no matter what is found. This one bears watching, though the Reds do have some depth ... The Lerners sent a letter to Nats fans saying that Stephen Strasburg would come back in September, comparing the situation to Jordan Zimmerman last season. Sources tell me the hardest part remaining in Strasburg's rehab is going to be keeping him under control. He feels like he could pitch much sooner, but the Nats are going to be ultraconservative ... Brad Lidge's biceps issue is worrisome, but he's barely participated in the past couple of springs. He is scheduled to pitch in a game on Tuesday. Assuming no setbacks, he'll be reading for the opener ... Justin Morneau's progress has been slower than the Twins had hoped, though sources tell me that much of the problem is mental. Morneau's had some people in his ear that some feel have held him back. They were willing to be patient, which was smart, as he's had no setbacks this spring and appears on track for Opening Day ... Ryan Zimmerman is scheduled to come back this week from his groin strain. He should be ready for the Nats' opener ... Joba Chamberlain is back throwing after resting his strained oblique. He's likely to be ready to start the season, though there's questions about whether Joe Girardi will use him normally. How he throws late this week will be key ... Casey Blake had some guided injections to help heal up his ribcage injury, but he's still very doubtful for Opening Day. The Dodgers were planning on resting him more this season anyway, but not like this ... There's a lot of concern in O's camp about Brian Roberts again, but they had to have seen this coming, right? ... Derrek Lee is having a tough spring. Just as he comes back from his thumb injury, he fouled a ball off his foot and needed X-rays. There's no break, but he'll miss some time ... Octavio Dotel isn't likely to make it back by Opening Day, which opens up another slot in a confusing Jays bullpen. Dotel's hamstring isn't thought to be a long term issue, but with Frankie Francisco also out, the saves situation is wide open ... There haven't been as many reports of "dead arm" as usual this spring. Jason Beck of MLB.com talked to some pitchers who told him that they've moved up their off-season throwing schedule some to combat this. It's another reason that Spring Training is too long ... You won't see his byline here, but behind the scenes, Dan Wade is making a lot of these columns possible. I just worry that like some of my previous report interns some team is going to steal him! ... We'll be doing this at least three times a week this season, plus quick reports as needed. As Earl Weaver (or was it Henry Abbot) once said, "We do this every day."

Will Carroll writes about sports injuries. You can email him or follow him on Twitter (@injuryexpert). He is a member of the BBWAA and PFWA.

 
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